Provider Demographics
NPI:1083620207
Name:HOLMES, LEANN R (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:R
Last Name:HOLMES
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:LEANN
Other - Middle Name:H
Other - Last Name:STOFFERAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:4809 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-1135
Mailing Address - Country:US
Mailing Address - Phone:402-477-9200
Mailing Address - Fax:
Practice Address - Street 1:4840 DODGE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-3111
Practice Address - Country:US
Practice Address - Phone:402-477-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
500028748OtherRAILROAD MEDICARE
NE10025121400Medicaid
NE900016712999Medicaid
P42245Medicare UPIN
274760Medicare ID - Type Unspecified
NEP42245Medicare UPIN